Provider Demographics
NPI:1477719532
Name:GENOVESE, PAOLA V (MD)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:V
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:
Other - Last Name:GENOVESE-PAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-7246
Practice Address - Fax:602-933-4341
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ546722080H0002X, 207RH0002X
OH35120948208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ296056Medicaid
OH0110081Medicaid